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The Eyes of Texas

OPTION 1. Adding by subtracting. I set out on my quest with the help of Dr. James P. McCulley, the chairman of ophthalmology at the University of Texas Southwestern Medical Center at Dallas. After an exhaustive set of eye exams all the way back to the retinas—something that every middle-ager should do regardless—I learned about the oldest way to permanently correct presbyopia: monovision. In this technique, the surgeon alters your nondominant eye (usually the left) to see close-up stuff with a Lasik procedure, leaving the dominant eye for distance. So instead of normal binocular vision—both eyes seeing the same thing at the same time—you go to one eye seeing far, the other near. The advantages? It’s relatively cheap (as little as $1,800 an eye), and the risk is not substantial. The bad news is that it can make you dizzy. Eventually you get over this, but it struck me as trading one kind of problem for another.

OPTION 2. Changing the hardware. The next recourse is to go with the higher-risk intraocular lens implant. I learned from McCulley that there are two kinds. Crystalens replaces your ossified lenses with new, synthetic ones, which are connected to your eyes with special hinges that ensure more pliability. In a one-year Food and Drug Administration study, the procedure had an adequate success rate; following surgery, almost all participants could pass a driver’s test, and about half could read a magazine without glasses. Then there’s ReSTOR, a newer technique developed by Alcon Laboratories, a leading eye-care company in Fort Worth. This procedure, which is considered a breakthrough because it doesn’t depend on the flexibility of a lens and its surrounding muscles to adjust your vision, replaces your stiff, tired eye lens with something called an apodized diffractive optic, which is sort of like a tiny bifocal lens. What particularly caught my eye about ReSTOR’s trial results is that more than 90 percent of treated patients can read a newspaper without glasses—and never need them again at a higher rate than Crystalens patients.

INCONCLUSION. ReSTOR in particular was tempting, but given that it’s surgery and costs about $4,000 to $5,000 an eye (as with Crystalens), I told McCulley I’d think about it. As I write this, I’m still thinking. It’s not that I don’t trust the techniques or that the cost is that prohibitive. Certainly any presbyopia sufferer should visit an ophthalmologist to explore these options. But personally, I’ve decided that I’m going to have to get a lot blinder before I opt for the knife. I figure the technology can only get better—and cheaper. Besides, I find myself growing attached to my reading glasses.

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ReSTOR: Inside the newest technique. If you do decide to fork over the cash (and since we’re talking elective surgery, you’ll certainly have to), you may wonder what exactly you’re getting yourself into. The ReSTOR procedure is actually fairly short and sweet, which can’t be said for very many medical operations. First, the surgeon anesthetizes your eyes and may give you a sedative to keep you calm. A tiny metal probe is employed to emulsify your natural lenses with high-frequency vibration. The area is then cleaned, and the artificial lenses are inserted. The whole process takes between fifteen and thirty minutes, not including pre- and post-op. In most cases, any discomfort disappears in a few hours, and theoretically, you will be seeing better the next day.